3.1.2 Introduction to Sepsis

Question 2

How does sepsis incidence vary with age?

Answer 2

Incidence triples b/t the ages of 65 and 85

Question 3

If those don’t stabilize the patient, what should be completed within 6 hours? (3)

Answer 3

1. Vasopressors (for hypotension that does not respond to initial fluid resuscitation) to maintain a MAP > 65 mm Hg
2. In event of persistent arterial hypotension despite volume resuscitation (septic shock) or initial lactate > 4mmol/L
   
   1. Measure CVP
   2. Measure central venous oxygen saturation (Scv02)
3. Re-measure lactate if initial lactate was elevated

Targets are: CVP 8 mm Hg, Scv02 > 70%, lactate normal

Question 4

You suspect sepsis?

Answer 4

D. IV levofloxacin, 2 L bolus of LR, transfer to hospital for ICU admission

Question 5

Answer 5

D. Suspected infection, SIRS, and organ dysfunction

Question 6

What is the fatality rate of severe sepsis?

Answer 6

30-50%

Question 7

Along with having a high mortality, sepsis survivors tend to have what long-term complications?

Answer 7

Cognitive impairment

Question 8

What is the major cause of morbidity and mortality worldwide?

Answer 8

Severe sepsis

Question 9

What are the SIRS criteria?

Answer 9

Most have 2 or more of the following:

Temp: > 38 C or < 36 C

HR: > 90 beat/min

Respirations: > 20/min

WBC: > 12,000 or < 4,000 or > 10% bands

Question 10

What differentiates severe sepsis from sepsis?

Answer 10

Organ dysfunction

Question 11

What are some organs that can be dysfunctional in sepsis? What are some clinical manifestions of this organ dysfunction?

Answer 11

Question 12

What are some of the time sensitive interventions?

Answer 12

Acute MI, Stoke, Sepsis, Trauma

Question 13

During examination, you determine that a patient has infection. What are the next two questions that you should ask yourself?

Answer 13

Does this patient have SIRS?

Do they have organ dysfunction?

Question 14

What is sepsis?

Answer 14

SIRS plus known or suspected infection

Question 15

How does the addition of one dysfunctional organ affect the mortality rate?

Answer 15

15%-20% for each dysfunctional organ

Question 16

In the early resuscitation of the severe sepsis patient, the MOST important feature is:

Answer 16

B. Antibiotics as fast as they can get in

Question 17

What 4 things should be done within 3 hours of sepsis onset?

Answer 17

1. Measure serum lactate levels
2. Obtain blood cultures prior to administration of antibiotics (1C)
3. Administer broad spectrum antibiotics (1B, 1C)
4. Administer 30 mL/kg crystalloid for hypotension or lactate > 4 mmol/L